Bradley M. Appelhans

BACKGROUND Increasing physical activity, including exercise, for older adults (OAs) is an almost universally beneficial strategy for reducing frailty and improving management of multimorbidity, thereby preserving independence. However, homebound, frail, multimorbid OAs have very limited access to exercise programs in the U.S., and prior exercise intervention trials are frequently based on in-person classes / coaching and rarely involve care partners. Increasing exercise among multimorbid, frail, homebound [EC2.1]OAs requires testing innovative methods of intervention delivery. OBJECTIVE The EngAGE trial is a 6-month, double blind, randomized controlled, in-home trial powered to test the efficacy of the EngAGE program versus paper-based NIA Go4Life® exercises in multimorbid, frail, homebound African American OAs residing in the community along with their self-selected care partners (CPs). METHODS EngAGE is a custom, socially-motivated exercise program delivering NIA Go4Life® exercises to multimorbid, frail, homebound OAs and their CPs in the home. We co-designed EngAGE with end users using iterative participatory design. The program delivers daily exercise (resistance, balance and flexibility) routines to OAs over a voice-activated device with a screen. CPs can provide social reinforcement that is read aloud to the OA over the device to motivate adherence. OA-CP dyads were randomized to either the: 1) EngAGE program (EngAGE arm), or 2) the NIA “Workout to Go” Go4Life® exercise handout along with an out-of-the-box voice-activated device (paper arm). The primary outcome is change in the performance of five repeated chair stands from the Short Physical Performance Battery. Secondary study outcomes were selected to: (a) further assess individual-level factors that may contribute to exercise participation and response, (b) examine the OA-CP social factors that may impact exercise participation and response, and (c) assess technology-related factors. An intention-to-treat analysis principle will be applied to all outcomes. A two-part mixed model to compare chair stands over time will be used. The first part will model the probability of being able to perform chair stands by a random-effects logistic regression, and the second part will compare chair stands performance time among those who are able to perform the test by a linear mixed model. RESULTS Funding began in July 2021. Recruitment occurred from October 2022 to February 2025 (n = 69 OA and n = 68 care partner). Data collection concluded in April 2026. Data analysis and submission for publication are expected to conclude by summer 2026. CONCLUSIONS The EngAGE trial will be one of the first RCTs that tests the impact of mode of delivery on the efficacy of a health intervention for multimorbid, frail, homebound OAs. It is also among the first to include CPs as a target participant of an OA physical activity intervention. Trial findings will generate guidance for future randomized controlled trials with OAs at highest risk of disability. CLINICALTRIAL ClinicalTrials.gov NCT05337514; https://clinicaltrials.gov/study/NCT05337514

Background: Cardiovascular health (CVH), defined as a composite of 8 health factors and behaviors ranging from body composition to sleep duration, is strongly associated with the risk for future cardiovascular events in adults. However, there is little data on CVH among contemporary, diverse cohorts of children and adolescents. Objective: This protocol describes the completed recruitment of a diverse pediatric e-cohort based in Chicago. We include details about ongoing longitudinal data collection for CVH behaviors, as well as neighborhood and environment-based socioeconomic factors, and linkage to electronic health records (EHRs) for direct capture of CVH factors. Methods: Young Hearts (YH) uses a longitudinal cohort design, linking participant responses to annual electronic surveys to EHRs. Parents/guardians of children aged 0-17 years and adolescents aged 18 years are asked to complete surveys at 3 e-visits, completed annually in consecutive years. Adolescents aged 12-17 years are invited to complete surveys at each e-visit to provide self-reports of their data in addition to their parents/guardians. As adolescents reach the age of majority, they re-consent and complete their remaining e-visit data. Participants’ clinical data are abstracted from EHRs at 6 health systems in Chicago and linked to their survey data. The main study outcome is the CVH score, adapted from the Life’s Essential Eight framework for use in pediatric populations. We will also study component CVH behaviors and factors, each assessed using developmentally-appropriate measures, including body mass index, blood pressure, lipids, glycemic control, diet, physical activity, sleep, and smoking exposure. Our innovative study design will allow us to model trajectories of pediatric CVH from birth through 20 years of age. Funding for this study was provided by the National Heart, Lung, and Blood Institute (R01HL155864). Results: The YH study, funded in March 2021, recruited, enrolled, and consented 7114 children and adolescents aged 0‐18 years between April 2022 and February 2025. Baseline surveys have been completed by 6651 participants, of whom 3259 (49%) were female, and the mean age was 7.4 (SD 5.4) years. Data collection is still in progress, with completion anticipated in February 2027. We aim to publish results beginning in 2026. Conclusions: This study will define the epidemiology of cardiovascular risk factors in a diverse, contemporary cohort of US children and adolescents and identify behavioral and structural individual- and area-level economic, psychosocial, and lifestyle factors associated with identified disparities. We anticipate that the YH cohort will become an ongoing resource for pediatric CVH research.

BACKGROUND AND OBJECTIVES: Children from lower-income households lose less weight in family-based weight management interventions, likely due to barriers to treatment attendance and adherence. The CHECK randomized controlled trial tested whether delivering pediatric weight management interventions in the home improves weight loss outcomes relative to clinic-delivered intervention. METHODS: Enrolled families included 269 children (137 boys) who were aged 6 to 12 years, had overweight/obesity, and lived in lower-income English- or Spanish-speaking households in Chicago, Illinois (2017–2022). All families received a 12-month pediatric weight management intervention with 18 planned in-person sessions and 12 planned telephone contacts. The sole difference between arms was the location (home vs clinic) of in-person intervention sessions. Intention-to-treat analyses compared treatment arms on 12-month change in BMI z-score (zBMI), intervention session attendance and contact time, and secondary clinical outcomes. RESULTS: Twelve-month zBMI change did not differ (P = .58) between the home-delivered (n = 133; −0.031, SD = 0.26) and clinic-delivered arms (n = 136; −0.002, SD = 0.30). Across both arms, session attendance and total contact time predicted larger decreases in zBMI. Both variables were higher in the home-delivered arm (median = 11 sessions, 500 minutes) than the clinic-delivered arm (median = 6.5 sessions, 315.5 minutes; P values < .001). Post hoc analyses indicated that home-delivered (vs clinic-delivered) intervention led to 0.03 (SE = 0.008, P = .0004) greater zBMI reductions across time points prior to the COVID-19 pandemic, but not after. CONCLUSIONS: Home delivery did not improve overall 12-month weight loss outcomes. Home-delivered intervention did increase session attendance and contact time and may have had beneficial weight loss effects prior to the COVID-19 pandemic.

Objective: This study examined predictors of physical performance, a key aspect of quality of life, in children with excess weight.Methods: Participants were 269 children aged 6–12 years with a body mass index above the 85th percentile. Children completed a standardized physical performance task capturing lower extremity strength, balance, and gait speed. Height, weight, and waist circumference were objectively measured, and daily moderate‐vigorous physical activity (min/day) and sedentary time (% of day) were assessed with a 7‐day accelerometer protocol.Results: Physical performance task completion averaged 15.0 (SD = 2.5) seconds. Children with higher body mass index z‐scores and waist circumferences had significantly longer task completion times. The task took 1.8 additional seconds per 1.0 body mass index z‐score (p < .001), and 1.2 additional seconds for every 20 cm higher waist circumference (p < .001). Daily moderate‐vigorous physical activity and sedentary time were unrelated to physical performance, and did not moderate its associations with the adiposity measures.Conclusion: Among children with excess weight, physical performance declines with increasing levels of total and central adiposity. Daily activity levels do not moderate this association. Interventions that directly target weight reduction would likely yield the greatest improvement in physical performance in children with overweight or obesity.